美國醫院公司 (HCA) 2024 Q2 法說會逐字稿

Welcome to the HCA Healthcare second quarter 2024 earnings conference call. Today's call is being recorded. And at this time for opening remarks and introductions, I would like to turn the call over to the Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

歡迎參加 HCA Healthcare 2024 年第二季財報電話會議。今天的通話正在錄音。現在，我想將電話轉給投資者關係副總裁弗蘭克·摩根先生進行開場發言和介紹。請繼續，先生。

Good morning and welcome to everyone on today's call. With me this morning, is our CEO, Samuel Hazen, and our CFO, Mike Marks. Sam and Mike will provide some prepared remarks and then we'll take some questions.

早安，歡迎大家參加今天的電話會議。今天早上和我在一起的有我們的執行長 Samuel Hazen 和財務長 Mike Marks。薩姆和麥克將提供一些準備好的發言，然後我們將回答一些問題。

Before I turn the call over to Sam let me remind everyone that should today's call contain any forward-looking statements that are based on management's current expectations. Numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today. More information or forward-looking statements, and these factors are listed in today's press release and in our various SEC filings.

在我將電話轉交給 Sam 之前，讓我提醒大家，今天的電話會議是否應該包含任何基於管理層當前預期的前瞻性陳述。許多風險、不確定性和其他因素可能導致實際結果與今天可能表達的結果有重大差異。更多資訊或前瞻性陳述，這些因素已在今天的新聞稿和我們向 SEC 提交的各種文件中列出。

On this morning's call, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA is included in today's release. This morning's call is being recorded and a replay of the call will be available later today.

在今天早上的電話會議上，我們可能會參考調整後 EBITDA 等指標，這是一項非 GAAP 財務指標。今天的發布中包含了一份表格，提供了調整後 EBITDA 和調節 HCA 淨利潤的補充資訊。今天早上的通話正在錄音，今天晚些時候將提供通話重播。

With that, I'll now turn the call over to Sam.

現在，我將把電話轉給 Sam。

All right. Thank you, Frank, and good morning, to everyone. The company's results for the second quarter were positive across the board and reflected strong demand for our services. In addition, our teams continue to execute our strategic plan effectively and produce positive outcomes for our patients while also enhancing efficiencies in our facilities, including better throughput and case management.

好的。謝謝你，弗蘭克，大家早安。該公司第二季的業績全面樂觀，反映出對我們服務的強勁需求。此外，我們的團隊繼續有效執行我們的策略計劃，為我們的患者帶來積極的成果，同時提高我們設施的效率，包括更好的吞吐量和病例管理。

I want to thank our HCA colleagues for their outstanding work and their continued pursuit to innovate and deliver on our mission. As compared to the prior year. Diluted earnings per share as adjusted increased 28% to $5.50. Consistent with the first quarter, we saw broad-based volume growth across our markets and service lines.

我要感謝我們的 HCA 同事所做的出色工作以及他們對創新和實現我們使命的持續追求。與上一年相比。調整後的稀釋每股收益成長 28%，達到 5.50 美元。與第一季一致，我們看到我們的市場和服務線的銷售量普遍成長。

On a same-facility basis in the second quarter, inpatient admissions grew 5.8% equivalent admissions grew 5.2%. Emergency room visits increased 5.5%, inpatient surgeries were up 2.6%, outpatient surgery cases were down 2% and like the first quarter, the declines were mostly explained by lower volumes in Medicaid and self-pay categories.

在第二季相同設施的基礎上，住院人數增加了 5.8%，同等住院人數增加了 5.2%。急診室就診量增加了 5.5%，住院手術量增加了 2.6%，門診手術量下降了 2%，與第一季一樣，下降的主要原因是醫療補助和自費類別的數量減少。

Similar to the past few quarters, other volume categories, including cardiac procedures and inpatient rehab services experienced strong growth. Payer mixes improved year over year with commercial volumes representing 36.2% of equivalent admissions. And lastly, the acuity of our inpatient services as reflected in our case mix index increased slightly as compared to last year.

與過去幾季類似，包括心臟手術和住院復健服務在內的其他業務量類別也經歷了強勁增長。付費方組合逐年改善，商業量佔同等入場量的 36.2%。最後，病例組合指數反映的住院服務的敏銳度與去年相比略有上升。

These factors helped generate same-facility revenue growth of 10%. Also in the quarter, we progressed further on our cost agenda and produced solid operating margins. As we transition to the last half of 2024, we are encouraged by the company's results, we believe the increased investments we are making in our people and facilities, along with our disciplined approach to operations will continue to produce positive outcomes for our stakeholders.

這些因素幫助實現了 10% 的同設施收入成長。同樣在本季度，我們在成本議程上取得了進一步進展，並產生了穩定的營業利潤率。隨著我們進入 2024 年下半年，我們對公司的業績感到鼓舞，我們相信我們對人員和設施的投資增加，以及我們嚴格的營運方法將繼續為我們的利害關係人帶來積極的成果。

In closing, given our year-to-date performance and the backdrop of strong demand that we forecast for the remainder of the year, we have updated our guidance for the year, as indicated in our press release.

最後，鑑於我們今年迄今的表現以及我們預測今年剩餘時間的強勁需求背景，我們更新了今年的指導，如我們的新聞稿所示。

With that, let me turn the call over to Mike for more details.

接下來，讓我將電話轉給麥克以了解更多詳細資訊。

Thank you, Sam. And good morning, everyone. The second quarter showed continued solid performance with strong demand and improved margins and a balanced allocation of capital. Sam reviewed our top line results, so I will cover operating costs in the quarter.

謝謝你，山姆。大家早安。第二季業績持續穩健，需求強勁，利潤率提高，資本配置均衡。薩姆審查了我們的頂線業績，因此我將承擔本季的營運成本。

Operating costs were well-managed, resulting in a margin improvement of 100 basis points to prior year and sequentially to the first quarter. Labor costs as a percent of revenue improved 200 basis points from the prior year, and we continued to see good results in contract labor which declined 25.7% from the prior year and represented 4.8% of total labor costs.

營運成本管理得當，導致利潤率比去年和第一季提高了 100 個基點。勞動成本佔收入的百分比比上年提高了 200 個基點，我們繼續看到合約工的良好業績，比上年下降 25.7%，佔總勞動成本的 4.8%。

Supply costs as a percent of revenues improved 50 basis points from the prior year, on other operating costs as a percent of revenue, they did grow compared to the prior year, but it remained relatively consistent for the past four quarters. We were encouraged that year over year same facility professional fee calls growth moderated to approximately 13% in the second quarter, which compares favorably to the 20% increase we experienced in the first quarter.

供應成本佔收入的百分比比上年提高了 50 個基點，其他營運成本佔收入的百分比確實比上年有所增長，但在過去四個季度保持相對穩定。我們感到鼓舞的是，第二季度同設施專業費用的同比增長放緩至 13% 左右，這與我們第一季 20% 的增長相比是有利的。

Adjusted EBITDA was $3.55 billion in the quarter, which represents a 16% increase over the prior year and included a modest benefit from Medicaid supplemental payments. As a management team, we're very pleased with the operational performance of the company. Now moving to capital allocation, we continued to deploy a balanced strategy of allocating capital for long-term value creation.

本季調整後 EBITDA 為 35.5 億美元，比上年增長 16%，其中包括醫療補助補充付款帶來的小額收益。作為管理團隊，我們對公司的營運表現感到非常滿意。現在轉向資本配置，我們繼續部署平衡的資本配置策略，以創造長期價值。

Cash flow from operations was just under $2 billion in the quarter, which is a decline of $500 million to prior year, driven by increase in tax payments and timing of Medicaid supplemental program accruals and cash receipts. Capital expenditures totaled $1.28 billion, and we repurchased $1.37 billion of our outstanding shares during the quarter, we also paid about [$7] million in dividends. Our debt to adjusted EBITDA leverage remains near the low end of our stated guidance range, and we believe we are well positioned from a balance sheet perspective.

本季營運現金流略低於 20 億美元，比上年同期減少 5 億美元，原因是納稅額增加以及醫療補助補充計畫應計項目和現金收入的時間安排增加。資本支出總計 12.8 億美元，我們在本季回購了 13.7 億美元的已發行股票，我們也支付了約 [7] 百萬美元的股息。我們的債務與調整後 EBITDA 槓桿率仍接近我們規定的指導範圍的低端，我們相信從資產負債表的角度來看，我們處於有利地位。

Finally, in our release this morning, we are updating estimated guidance for 2024. For revenues our new guidance range is $69.75 billion to $71.75 billion, net income attributable to HCA Healthcare $5.675 billion to $5.975 billion. Adjusted EBITDA, $13.75 billion to $14.25 billion and diluted earnings per share $21.60 to $22.80 per share. Based on the strength of our year-to-date results and our revised outlook, we estimate the share repurchases will be around $6 billion in 2024, subject to market conditions.

最後，在今天早上的發布中，我們更新了2024 年的預估指引。 59.75 億美元。調整後 EBITDA 為 137.5 億美元至 142.5 億美元，稀釋後每股收益為 21.60 美元至 22.80 美元。根據我們今年迄今的強勁業績和修訂後的前景，我們預計 2024 年股票回購額將達到 60 億美元左右，具體視市場情況而定。

With that, I'll turn the call over to you, Frank for questions and answers.

法蘭克，我會把電話轉給你，請你提問並回答。

Thank you, Mike. As a reminder, please limit yourself to one question. So, we might get as many as possible in the queue an opportunity to ask a question. Ellie you may now get instructions to those who would like to ask a question.

謝謝你，麥克。提醒一下，請限制自己回答一個問題。因此，我們可能會在隊列中獲得盡可能多的提問機會。艾莉，您現在可以向那些想要提問的人提供指示。

(Operator instructions)

（操作員說明）

AJ Rice, UBS.

AJ 賴斯，瑞銀集團。

Hi, everybody. Congratulations on a good quarter there, maybe just two areas that people are very focused on as supplemental payments. How is that running relative to your expectations and in your back half comments? Are you including anything for Tennessee and then the other area to be in the public exchanges, what is the trend there year over year? And how much is growth in that helping for these strong results.

大家好。恭喜這個季度的良好表現，也許只有兩個領域是人們非常關注的補充付款領域。與您的期望和後半部分的評論相比，情況如何？您是否包括田納西州和其他地區要進行公共交流的內容，這些地區逐年的趨勢是什麼？成長對這些強勁業績的貢獻有多大？

Hey, thank you A J, this is Mike. I'll take the supplemental question. I think you are where Medicaid has historically been our most challenging payer, really other than patients without insurance, typically paying us significantly below the cost of caring for Medicaid patients. Over the last several years, most states in which we operate have implemented or enhanced Medicaid reimbursement through supplemental payment programs.

嘿，謝謝你，AJ，這是麥克。我來回答補充問題。我認為醫療補助歷來是我們最具挑戰性的付款人，實際上除了沒有保險的患者之外，通常向我們支付的費用遠低於醫療補助患者的護理費用。在過去的幾年中，我們開展業務的大多數州都透過補充付款計劃實施或加強了醫療補助報銷。

And while these supplemental programs are growing, it is important to put them in context, they can be complex variable in their impact from quarter to quarter and when taken together with historical Medicaid reimbursement are still well short of covering the costs to treat Medicaid patients. We believe it is important to understand the backdrop when discussing these programs.

雖然這些補充計劃正在增長，但重要的是要將它們放在具體背景中，它們在每個季度的影響方面可能是複雜的變量，並且與歷史醫療補助報銷一起考慮時，仍然遠遠不足以覆蓋治療醫療補助患者的費用。我們認為，在討論這些計劃時了解背景非常重要。

But now to the quarter. In the second quarter, we recognized a year over year earnings increase of approximately $125 million related to our Medicaid supplemental payment program driven primarily by the new program in Nevada and the accrual of the Florida program, which began in the fourth quarter of 2023.

但現在到了季度。第二季度，我們確認與醫療補助補充支付計劃相關的收入同比增長了約1.25 億美元，這主要是由內華達州的新計劃和2023 年第四季度開始的佛羅裡達州計劃的應計費用推動的。

To your specific question about the new program in Tennessee. We that is with CMS for review and we do not anticipate financial impact from that program in 2024, if you want to go to the public exchanges for the first quarter and let me just kind of give commercial volumes in general first, and then we'll kind of breakout hits.

關於您關於田納西州新計劃的具體問題。我們正在與 CMS 進行審查，如果您想了解第一季的公共交易情況，我們預計該計劃不會在 2024 年產生財務影響，讓我先提供總體商業量，然後我們'都會有突破性的打擊。

But our equivalent admissions for managed care, including our healthcare exchange volumes were up 12.5% in this quarter versus the prior year quarter. If you take our managed care volumes with health, health care changes, they were up just short of 5% on equivalent admissions. And for healthcare changes, we were up 46% over prior year for the quarter.

但本季我們管理式醫療的同等入院人數（包括醫療保健交易量）比去年同期增加了 12.5%。如果您將我們的管理式醫療量與健康、醫療保健變化結合起來，您會發現，與同等入院人數相比，它們僅增長了不到 5%。對於醫療保健變化，本季我們比去年同期成長了 46%。

Okay, thanks a lot.

好的，非常感謝。

So, A J. On the volumes update, as I mentioned, as Mike alluded to there, I mean, our Medicare volumes were up, I think, by 6.5%. So, the volume was supported really across all payer categories. Clearly, the exchanges with the enrollment over the last three years or so has become a bigger component of the business. It's still relatively small in comparison to the other payer classes. But nonetheless, we did see good volume across all payer classes with the Medicaid, I think the only category that was down.

所以，A J。因此，該數量確實得到了所有付款人類別的支持。顯然，過去三年左右的招生交流已成為業務的重要組成部分。與其他付款類別相比，它仍然相對較小。但儘管如此，我們確實看到醫療補助的所有付款類別都有良好的交易量，我認為這是唯一下降的類別。

In Medicaid were down 10% on equivalent admissions mostly related to Medicaid redeterminations.

在醫療補助計劃中，同等入院人數下降了 10%，主要與醫療補助計劃的重新確定有關。

Okay, great. Thanks a lot.

好的，太好了。多謝。

Ann Hynes, Mizuho Securities.

安·海因斯，瑞穗證券。

Great and thanks. Can we talk about SW&B, it was down quarter sequentially, it is usually flat. Is that just driven by contract labor improvement? And if you can give us just any details on temporary labor as percentage of total contract labor and things like that, that would be great. Thank you.

太棒了，謝謝。我們可以談談 SW&B，它連續一個季度下降，通常持平。這僅僅是由合約工改善所推動的嗎？如果您能給我們提供臨時工佔合約工總數的百分比等任何詳細信息，那就太好了。謝謝。

Sure, thanks. And contract labor was down 25%, 27% this quarter versus prior year quarter. As I noted in my opening comment, contract labor percentage of revenue I'm sorry, percentage of SWB was at 4.8% in the quarter. This compares to 6.8% in the second quarter of last year and almost 10% at the height of COVID in early 2022.

當然，謝謝。本季合約工數量與去年同期相比分別下降了 25% 和 27%。正如我在開場白中指出的那樣，合約工佔收入的比例很抱歉，本季 SWB 的比例為 4.8%。相較之下，去年第二季為 6.8%，2022 年初新冠肺炎高峰期則接近 10%。

So we're continuing to see the improvements from all the work we're doing around recruiting and around retention, and that's paying the dividends in contract labor. If you think about kind of wage inflation, wage inflation was stable and kind of continues to run where we expected it to run. So all of that, we were pleased with our labor results for the quarter.

因此，我們繼續看到我們在招聘和保留方面所做的所有工作都取得了進步，這就是合約工帶來的紅利。如果你考慮一下薪資通膨，你會發現薪資通膨是穩定的，並且繼續按照我們的預期運作。因此，我們對本季的勞動成果感到滿意。

And seasonally, we do tend to drop from the first quarter to the second quarter, because some of the payroll taxes that we have to absorb in the first quarter are consumed by the end of the quarter or the early part of the second quarter, and that tends to improve a little bit of our metrics simply because of the timing of those tax payments.

而且從季節性來看，我們確實傾向於從第一季度到第二季度下降，因為我們在第一季必須吸收的一些工資稅在季度末或第二季度初就被消耗掉了，而且這往往會稍微改善我們的指標，只是因為這些繳稅的時間。

Great. Thanks.

偉大的。謝謝。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Hey, good morning, guys. Just a quick question, can you bridge us to the back half EBITDA raise for this year? What percent of the upside you're changing is coming from better volumes, what percent is coming from changes to pricing mix or acuity and how much is going from just better margin improvement coming from labor? And then finally, are there any [changes] supplemental assumptions for the back half of the year versus original guidance?

嘿，早上好，夥計們。只是一個簡單的問題，您能否為我們介紹今年後半段 EBITDA 的提高情況？您所改變的收益中有多少來自於銷售量的增加，有多少來自於定價組合或敏銳度的變化，有多少來自於勞動力帶來的更好的利潤改善？最後，與最初的指導相比，下半年是否有任何[變化]補充假設？

Yeah, Pito, good morning. So, we are obviously really pleased with our year-to-date June performance and kind of sense are thinking about the back half of the year on the top line, our volume and payer mix for the first six months of this year were better than our original expectations. Solid labor management, as we just talked about, including the but the contract labor declines also contributed to our thinking around, kind of our results.

是的，皮托，早安。因此，我們顯然對今年迄今 6 月的表現感到非常滿意，並且有一種感覺正在考慮今年下半年的營收情況，今年前六個月的交易量和付款人組合優於我們原來的期望。正如我們剛才談到的那樣，紮實的勞動力管理，包括合約工的下降，也有助於我們思考我們的結果。

As we move into the back half of the year, we believe most of these trends should continue and we anticipate volume growth to be in the 4% to 6% range for the year. We expect salary, wages and benefits, supplies and other operating expenses as a percent of revenue to run mostly where we did June year to date, contract labor as a percentage of salary, wages and benefits is projected to be in roughly in the mid 4% range in the back half of 2024. And we do expect professional fee expense growth to the prior year to moderate a bit more in the back half of 2024 as well.

當我們進入今年下半年時，我們相信大多數這些趨勢應該會持續下去，並且我們預計今年的銷售成長將在 4% 至 6% 的範圍內。我們預計工資、工資和福利、用品和其他營運費用佔收入的百分比將基本與今年 6 月迄今的水平持平，合約工佔工資、工資和福利的百分比預計將大致在 4 左右2024 年下半年的百分比範圍。 我們確實預期2024 年下半年專業費用支出較前​​一年的成長也會放緩。

Specifically on Medicaid supplemental payments. As you recall, in our original guidance, we anticipated a headwind of $100 million to $200 million from the Medicaid supplemental programs. As we've noted previously, these programs are complex and have a lot of variability quarter to quarter.

特別是醫療補助補充付款。您還記得，在我們最初的指導中，我們預計醫療補助補充計劃將帶來 1 億至 2 億美元的阻力。正如我們之前指出的，這些計劃很複雜，每個季度都有很大的變化。

But given that we are now deeper into 2024 and have better visibility into the programs across our states, we now anticipate an approximate $100 million to $200 million tailwind in 2024 from Medicaid supplemental payment programs, much of which occurred in the first half of 2024.

但考慮到我們現在已經進入2024 年，並且對各州的計劃有了更好的了解，我們現在預計2024 年醫療補助補充支付計劃將帶來約1 億至2 億美元的順風車，其中大部分發生在2024 年上半年。

Great. Thanks so much.

偉大的。非常感謝。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Hey, good morning, guys, and congrats on a solid quarter. Maybe Sam, just as we think about you called out Medicaid with the redeterminations kind of dragging on volumes a little bit here, but still very, very good performance. So just curious, where you stand now as you think about the sustainability of this elevated utilization trends?

嘿，早安，夥計們，祝賀本季業績穩定。也許薩姆，正如我們所認為的那樣，您呼籲醫療補助計劃，重新確定有點拖累這裡的數量，但仍然非常非常好的表現。所以我很好奇，當您考慮這種利用率上升趨勢的可持續性時，您現在處於什麼位置？

Well, as Mike just mentioned, Brian, we do expect that these volume trends will continue throughout 2024. And we have had for including 2023, really solid volume growth. I think when we pull up and we look at volume for the company and overall demand for our services, it starts with the markets that we serve. We are in markets, as we indicated at our Investor Day that we think have solid characteristics that are going to support organic growth. That's the first thing.

好吧，正如 Mike 剛才提到的，Brian，我們確實預計這些銷售趨勢將在 2024 年持續下去。我認為，當我們停下來觀察公司的銷售和對我們服務的整體需求時，首先要從我們服務的市場開始。正如我們在投資者日所指出的那樣，我們認為市場具有支持有機成長的堅實特徵。這是第一件事。

The second thing is the HCA network way, and that is how we build our networks, how we execute inside of that. Our inpatient bed capacity is up 2% year-over-year. When you look at us across all of our facilities, we've added a few hospitals in that as well. Really small ones that are complementary, our outpatient facilities overall are up 5%.

第二件事是 HCA 網路方式，這就是我們如何建立網路以及如何在其中執行。我們的住院床位容量年增 2%。當您查看我們所有的設施時，您會發現我們還添加了一些醫院。非常小的互補性，我們的門診設施整體成長了 5%。

So our network development is a key part of our growth and we think it's part and parcel to our ability to grow our market share, which we have grown and we continue to see a metric that suggest our market share continues to be positive.

因此，我們的網路發展是我們成長的關鍵部分，我們認為這是我們擴大市場份額的能力的重要組成部分，我們已經擴大了市場份額，並且我們繼續看到表明我們的市場份額繼續保持積極的指標。

The third thing for us is capital we are investing heavily and who we are. We're investing in our networks, we're investing in our people, we're investing in clinical technology for our physicians, and we're finding ways to use our capital to make our services better and produce better outcomes for our patients. So this year, we'll invest somewhere around $5.2 billion, which is significantly up over the last couple of years, and we continue to see opportunities inside of our organization to invest capital.

對我們來說，第三件事是我們正在大量投資的資本以及我們是誰。我們正在投資我們的網絡，我們正在投資我們的員工，我們正在為我們的醫生投資臨床技術，我們正在尋找利用我們的資本來改善我們的服務並為我們的患者帶來更好的結果的方法。因此，今年，我們將投資約 52 億美元，這在過去幾年中顯著增加，並且我們繼續在我們的組織內部看到投資資本的機會。

The next area, it's hard for us to know this, but we do believe that coverage when people are covered, whether it's through the exchanges, mostly through their employers through Medicare, they can to purchased services and so coverage is up, so that helps elevate demand.

下一個領域，我們很難知道這一點，但我們確實相信，當人們受到保險覆蓋時，無論是透過交換，主要是透過他們的雇主透過醫療保險，他們都可以購買服務，因此保險範圍增加，這會有所幫助提升需求。

And we are in really unchartered territories for growth in demand in a normal environment. And it's hard to know if there's a hangover from COVID, as we've mentioned in past calls, and so forth. But we do believe the fundamental attributes of coverage help support demand growth.

在正常環境下，我們確實處於需求成長的未知領域。正如我們在過去的電話會議中提到的那樣，很難知道新冠病毒是否會造成後遺症。但我們確實相信保險的基本屬性有助於支持需求成長。

And then when you start looking across, like we said earlier, the different payer classes, it's broad-based it's broad-based across the different payers. It's broad-based across our services I mean, the even obstetrics was up slightly in the quarter.

然後，當您開始查看時，就像我們之前所說的那樣，不同的付款人類別，它是基礎廣泛的，它是在不同的付款人中基礎廣泛的。我的意思是，它在我們的服務中具有廣泛的基礎，甚至產科在本季度也略有上升。

So we have seen just sort of a lift across all aspects of our business. And again, the diversification of HCA from market to market as well as the diversification from services, service allows us to participate in this demand growth and we're pretty encouraged by what we see year to date and what we expect over the balance of this year.

所以我們看到我們業務的各個方面都有所提升。再說一次，HCA 市場的多元化以及服務的多元化使我們能夠參與這種需求成長，我們對今年迄今為止所看到的情況以及我們對這一平衡的預期感到非常鼓舞年。

Awesome Sam, thank you.

很棒的薩姆，謝謝你。

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Thank you very much. I was wondering if you could comment a little bit more on the sources of acuity strength that you continue to see, when [we parse] that out between maybe the two midnight rule investments and higher acuity capabilities or if there's a we like we heard some MCOs talk about higher acuity and continuing Medicaid books and then maybe even some pull through pull forward of acuity ahead of members being re-determined off. I just wanted to get any indication of kind of where you're seeing that acuity growth? Thank you.

非常感謝。我想知道您是否可以對您繼續看到的敏銳度強度的來源進行更多評論，當[我們解析]這可能是在兩個午夜規則投資和更高的敏銳度能力之間，或者如果有我們喜歡我們聽到的一些MCO 談論更高的敏銳度和持續的醫療補助書籍，甚至可能在會員被重新確定之前，有些人會繼續提高敏銳度。我只是想知道你在哪裡看到了敏銳度的成長？謝謝。

Well, this is Sam. Let me speak to sort of our core strategy. Our core strategy is to create sort of a one-stock capability within our systems. And by that, I mean the ability to take care of a patient's need regardless of what their condition happens to be. So, we over time, have built a complexity in the services that we've offered.

嗯，這是薩姆。讓我談談我們的核心策略。我們的核心策略是在我們的系統內創造單一庫存能力。我的意思是，無論患者的病情如何，都能滿足患者的需求。因此，隨著時間的推移，我們所提供的服務變得越來越複雜。

So we've enhanced trauma programs. We've enhanced transplant programs, we've enhanced neonatal services, we've opened up our infrastructure with our transfer centers with helicopters with ground transportation. We've interacted with the rural community in a way to support the health care needs there, which typically tends to be more acute care service requirements, there not.

所以我們加強了創傷計畫。我們加強了移植計劃，加強了新生兒服務，我們開放了我們的基礎設施，包括配備直升機和地面交通的轉運中心。我們與農村社區互動，以支持那裡的醫療保健需求，這通常往往是更緊急的護理服務需求，但那裡卻沒有。

And so all of that has been part and parcel of thought toward our network strategy over the years. I will tell you again, we had broad-based service growth in trauma in the number of ambulance deliveries that occurred at our hospitals. Our cardiac care or cardiac surgery was up. So, we had neonatal admissions were up all of these components that I mentioned that are essential to our network strategy saw growth. And so that has naturally lifted the case mix and the acuity of the patients that we serve.

因此，多年來，所有這些都是我們網路戰略思想的重要組成部分。我會再次告訴你，我們醫院的救護車運送數量在創傷方面的服務有了廣泛的增長。我們的心臟護理或心臟手術已經完成。因此，我們的新生兒入院率上升了，我提到的所有這些對我們的網路策略至關重要的組成部分都出現了成長。因此，這自然提高了病例組合和我們服務的患者的敏銳度。

The two-midnight rule is actually dilutive when it comes to our case mix on the inpatient side. So, we jump over the implications of the two-midnight rule because those are lower acute patients, the observed deserving to be in an inpatient status, but nonetheless, less than average acuity by comparison. So our quarter suggests that the acuity and the complexity of the services that we offer is even more than what it reports out simply because of the dilutive effect of the two-midnight rule.

對於住院病人的病例組合來說，午夜兩點的規則實際上是稀釋了的。因此，我們跳過了午夜兩點規則的含義，因為這些患者的急性程度較低，觀察到的患者應該處於住院狀態，但相比之下，其敏銳度仍低於平均水平。因此，我們的季度表明，我們提供的服務的敏銳度和複雜性甚至超過了其報告的內容，這僅僅是因為午夜兩點規則的稀釋效應。

Thank you.

謝謝。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Thanks. Good morning. Sam I wanted to get your view on one of the bigger questions we're all getting from investors heading into the elections, which is the potential for exchange disruption, should be a chance to subsidies be allowed to expire at the end of 2025?Had the company run any scenario analysis of what happens to these volumes and hospital economics, should those subsidies expire?

謝謝。早安. Sam，我想聽聽您對選舉前投資者提出的一個更大問題的看法，即交易所中斷的可能性，是否應該有機會允許補貼在 2025 年底到期？發生什麼情況進行了任何情境分析，這些補貼是否應該到期？

And if not, maybe you could just share with us what you think happens of patients in terms of coverage we might drop from the exchanges today become uninsured, do you think they move to other payer types? And then if I could just squeeze in one number question, can you tell us what same-store ASC revenue growth was in the quarter. Thanks.

如果沒有，也許您可以與我們分享您認為患者會發生什麼情況，我們今天可能會從交易所放棄保險，變得沒有保險，您認為他們會轉向其他付款人類型嗎？然後，如果我能問一個數字問題，您能否告訴我們本季同店 ASC 收入成長情況是多少？謝謝。

On the exchanges, Justin, obviously, there's a lot to play out here politically between now and the end of the year. So, it's a little premature for us to our forecast, what's going to happen politically with respect to the exchanges, it's no secret that they are scheduled to expire at the end of 2025 and many of the participants are in states that we serve. Obviously, you're seeing that in the data that's available. We don't have a great line of sight on which participants in the exchange have what level of subsidies and how that will play out?

在交流方面，賈斯汀，顯然，從現在到今年年底，政治上有很多事情要做。因此，對於我們的預測來說，關於交易所在政治上會發生什麼的預測還為時過早，眾所周知，它們計劃於 2025 年底到期，而且許多參與者都在我們服務的州。顯然，您在可用的數據中看到了這一點。我們對交易所的哪些參與者獲得何種程度的補貼以及補貼將如何發揮沒有明確的了解？

It's really difficult for us to know precisely what that is. We are starting to drive that study as much in (inaudible) study and we're hopeful that in 2025, we'll have some sense of the policies that might be put forth a better sense of the economics around the exposure, if the subsidies go away.

我們確實很難確切地知道那是什麼。我們開始在（聽不清楚）研究中推動這項研究，我們希望到2025 年，我們將對政策有一定的了解，如果補貼能夠實現的話，這些政策可能會更好地了解圍繞風險敞口的經濟學離開。

But at this point in time, it's way too early for us to make any judgments on that. But we will be as transparent as we possibly can be with you all around it once we have information that we feel we can support and share appropriately.

但目前我們對此做出任何判斷還為時過早。但一旦我們掌握了我們認為可以支持和適當分享的信息，我們將盡可能地與您保持透明。

Hey, Justin. On same-store ASC revenue growth is about 8%.

嘿，賈斯汀。同店ASC營收成長約8%。

Great. Thanks, guys.

偉大的。多謝你們。

Thank you.

謝謝。

Whit Mayo, Leerink Partners.

惠特·梅奧，Leerink 合夥人。

Hey, thanks. Sam you've talked a lot in recent quarters around the efficiencies and the throughput initiatives that you have the ER, any numbers that you can share around any of those productivity gains that puts this in perspective, maybe we see it on the back end with length of stay? And just if you could comment on the commercial our growth in the ER this quarter? Thanks.

嘿，謝謝。 Sam，您最近幾季談論了很多有關 ER 的效率和吞吐量計劃的內容，您可以分享有關生產力提升的任何數字，以便正確看待這一點，也許我們可以在後端看到它停留時間？您能否對我們本季急診室的商業成長發表評論？謝謝。

Okay. Let me start with the commercial ER our growth. Our commercial volumes in the emergency grew almost 18%, a really strong growth in that category. Again, we are focused on throughput, patient satisfaction and high clinical performance with what we call our ER revitalization program and our ER revitalization program has produced really positive results for us, our throughput.

好的。讓我從商業急診室的發展開始。我們在緊急情況下的商業銷量成長了近 18%，在該類別中成長非常強勁。同樣，我們透過所謂的 ER 振興計劃專注於吞吐量、患者滿意度和高臨床表現，我們的 ER 振興計劃為我們的吞吐量帶來了真正積極的結果。

Let's start with time to see a patient is down to minutes, that doesn't sound like that much. While we're moving from 11 to 9 minutes, that's the starting point. Our length of stay for patients who have been discharged is down, I think about 15% to 20% to around 160 minutes or something in that zone. Again, throughput getting the patient through the system communicating with them effectively and then getting them out when they're ready to be out.

讓我們從看病人的時間縮短到幾分鐘開始，這聽起來並沒有那麼多。當我們從 11 分鐘調整到 9 分鐘時，這就是起點。我們出院患者的住院時間縮短了，我認為減少了 15% 到 20%，大約 160 分鐘左右。同樣，吞吐量讓患者透過系統與他們進行有效的溝通，然後在他們準備好出去時讓他們出去。

Then we have patients who are admitted for those patients, we've also improved the whole time in the emergency room so we can get them up to a floor and in a proper setting for care. And that also has improved markedly on a year over year basis, we have room to go and we're continuing to invest in our leadership development, we're continuing to invest in our technology.

然後我們收治了這些患者，我們還改善了急診室的整個時間，這樣我們就可以將他們送到樓層並在適當的環境中進行護理。這也逐年顯著改善，我們還有空間，我們將繼續投資於我們的領導力發展，我們將繼續投資於我們的技術。

We put our Care Transformation and Innovation team inside of our ER processes to help them think about different approaches. Our patient satisfaction has improved in our emergency room. And I want to say over 8 out of 10 patients would highly recommend or recommend an HCA emergency room.

我們將護理轉型和創新團隊納入急診室流程中，幫助他們思考不同的方法。我們急診室的患者滿意度有所提升。我想說超過十分之八的患者會強烈推薦或推薦 HCA 急診室。

In addition to that, we're adding capacity. We've added capacity on our hospital campuses, but we've also added capacity off-campus to really meet the needs of different communities, and that's been part of our growth as well. And we continue to invest in both aspects from a supply standpoint and then we're investing heavily in our process standpoint with to make sure that we're delivering the services that our communities need and that our patients deserved. And I'm really proud of the ER efforts that our teams have put forth. Thank you.

除此之外，我們還在增加容量。我們增加了醫院院區的容量，但我們也增加了院外的容量，以真正滿足不同社區的需求，這也是我們成長的一部分。從供應的角度來看，我們繼續在這兩個方面進行投資，然後我們在流程的角度進行大量投資，以確保我們提供社區所需的服務以及患者應得的服務。我對我們的團隊在急診室所做的努力感到非常自豪。謝謝。

Thanks.

謝謝。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, good morning. One clarification and a question of first, can you just give us the exchange admissions as a percentage of total in the quarter. And then on the question, outpatient surgeries were down about 2%. Can you elaborate on some of the trends you're seeing there and maybe break that out between hospital outpatient and ASC volumes? Thanks.

早安.首先需要澄清一個問題，您能否向我們提供本季度交換生招生人數佔總數的百分比。然後就這個問題而言，門診手術量下降了約 2%。您能否詳細說明您在那裡看到的一些趨勢，並可能在醫院門診量和 ASC 量之間進行區分？謝謝。

Yes. So, on exchange volumes, they're just right at 7% of admissions and ER visits as well for exchange as a percentage of total. What was second question?

是的。因此，就交換量而言，他們的入院率和急診就診量以及交換佔總數的百分比正好為 7%。第二個問題是什麼？

It was on the outpatient surgery.

這是門診手術。

I've got it right. So, we were down in the quarter 2% in the hospital in the same way back up to the non-same stores here, sorry. Yeah, we're a little over 2% on same stores and a little over 1% on ASC and that weighted out to about the 2% that we mentioned again.

我做對了。因此，我們在醫院的季度下降了 2%，以同樣的方式回到這裡的非相同商店，抱歉。是的，我們在同一家商店的銷售額略高於 2%，在 ASC 的銷售額略高於 1%，加權後的銷售額約為我們再次提到的 2%。

It's exclusively in Medicaid and uninsured, so our overall revenue growth in our ASCs and hospital outpatient surgery platform was up, our profitability on that segment was up and, yes we have a volumetric that's down, but the implications to our business really aren't there as a result of it.

它完全屬於醫療補助且沒有保險，因此我們的ASC 和醫院門診手術平台的整體收入增長了，我們在該領域的盈利能力上升了，是的，我們的銷量有所下降，但對我們業務的影響確實沒有增加那裡作為它的結果。

Great. Thank you.

偉大的。謝謝。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Hi, thanks. Just a couple more on the guidance. I was hoping to hear if you've updated your thinking on core wage inflation as part of this guidance revision, wondering if that's a contributor potentially not due to the higher volumes are starting to? And then if there's any impact of M&A in the guidance, you remember have an [EBITDA decreased to know too]. Thanks.

你好謝謝。關於指導，還有一些內容。我希望聽到您是否更新了對核心工資通膨的看法，作為本指導修訂的一部分，想知道這是否是一個潛在的貢獻者，而不是由於數量開始增加？然後，如果指導意見中存在併購的任何影響，您記得[EBITDA 也下降了]。謝謝。

If you look at wage inflation. You know, we kind of came in this year, we were thinking then 2.5% to 3% range. And that stayed consistent as we think about where we are here and how we're going to, kind of close to the back half of the year. So, as we're thinking, wage inflation will be fairly steady.

如果你看看薪資通膨。你知道，我們今年進來了，當時我們考慮的是 2.5% 到 3% 的範圍。當我們思考我們現在所處的位置以及我們將如何發展時，這種情況一直保持一致，接近今年下半年。因此，正如我們所想，薪資通膨將相當穩定。

And then it's more into M&A.

然後更多的是併購。

So there were some questions on M&A that kind of run through that. So, you have $400 million of revenue in new stores that $250 million of that is from Valesco the rest are from the acquisitions in Texas. You heard us talk about the healthcare system acquisition a couple of others.

因此，存在一些關於併購的問題。因此，新店的收入為 4 億美元，其中 2.5 億美元來自 Valesco，其餘來自德州的收購。您聽到我們談論了其他一些醫療保健系統的收購。

And that's the revenue side of that it was diluted to earnings, though, at about 1% negative impact to EBITDA for the quarter. So, the M&A trends don't really impact or did not really impact our year over year EBITDA growth in any material way.

不過，這就是收入方面，它被稀釋到了收益中，對本季的 EBITDA 產生了約 1% 的負面影響。因此，併購趨勢並沒有真正影響或沒有以任何實質方式影響我們的 EBITDA 逐年成長。

Thank you.

謝謝。

Scott Fidel, Stephens Inc.

斯科特·菲德爾，史蒂芬斯公司

Hi, thanks. Good morning. Was hoping to just circle back on the Medicaid supplemental payments. And maybe if you could just sort of talk about how your Medicaid margins have evolved from maybe where they were a couple of years ago to where they are currently inclusive of the Medicaid supplemental payments. I know that you had mentioned how this is really just trying to get the business still Medicaid back closer on to breakeven or maybe not even there yet.

你好謝謝。早安.希望只是回到醫療補助補充付款。也許您可以談談您的醫療補助利潤如何從幾年前的水平發展到目前包含醫療補助補充付款的水平。我知道您曾經提到過，這實際上只是想讓醫療補助業務更接近盈虧平衡點，甚至可能還沒有達到盈虧平衡點。

So helpful if you could sort of walk us through that. And then just looking out to the elections, there is a level of investor uncertainty around the sustainability of Medicaid supplemental payments. If there was a switch off in the White House, although I do think it's notable that we do see many of the states that are sponsoring are these payments are from red states. So, it feels like these payments likely would be quite sustainable but there is a lot of investor uncertainty around this topic, so we certainly appreciate your thinking on that? Thanks.

如果您能引導我們完成這一點，那就太有幫助了。展望選舉，投資者對醫療補助補充付款的可持續性存在一定程度的不確定性。如果白宮關閉，儘管我確實認為值得注意的是，我們確實看到許多贊助的州這些付款都來自紅色州。所以，感覺這些付款可能是相當可持續的，但投資者圍繞這個主題存在許多不確定性，所以我們當然感謝您對此的想法？謝謝。

Yeah, thank you. I'll take the second one first, we do see good sustainability around the Medicaid supplemental payment programs. As you noted, they're well supported historically both in red states and blue states. And you know, frankly, two of our biggest programs are in Texas and Florida.

是的，謝謝。我首先考慮第二個，我們確實看到醫療補助補充支付計劃具有良好的可持續性。正如您所指出的，他們在歷史上在紅州和藍州都得到了很好的支持。坦白說，您知道，我們最大的兩個項目位於德克薩斯州和佛羅裡達州。

So that will give you a sense of those things. The new rule that came out earlier this year on sustainable programs on a Medicaid supplemental programs, we found to be positive and supportive of and actually good for the provider industry.

這會讓你對這些事情有所了解。今年稍早出台的關於醫療補助補充計劃的可持續計劃的新規則，我們發現對提供者行業是積極和支持的，實際上是有好處的。

If you think about kind of margins over time, if you go historically back in time with Medicaid margins. And you're right, I mean, supplemental payments are really just core to Medicaid, they were pretty significantly below the cost of caring for Medicaid patients in the past over the last several years, they have grown some and more states have added programs or enhanced programs.

如果你考慮一段時間內的利潤率，如果你回顧一下醫療補助利潤率的歷史。你是對的，我的意思是，補充付款實際上只是醫療補助的核心，在過去幾年中，它們遠低於過去幾年照顧醫療補助患者的成本，它們已經發展了一些，越來越多的州增加了計劃或增強的程序。

But even now if you look at where we are in 2024. And you think about the historical kind of base Medicaid reimbursement plus a supplemental payment reimbursement, it's still pretty well short of the cost of caring for those patients. So, and that's the context that we would provide on that.

但即使是現在，如果你看看 2024 年我們所處的位置。這就是我們將提供的背景。

Jason Cassorla, Citigroup.

傑森‧卡索拉，花旗集團。

Great, thanks. Good morning. I just wanted to ask on CapEx, sounds like you're maintaining your outlook there. But just in context of the higher 2024 revenue and EBITDA outlook, I guess curious if there's anything to call out on the CapEx side.

萬分感謝。早安.我只是想問資本支出，聽起來您仍維持對資本支出的看法。但在 2024 年收入和 EBITDA 前景較高的背景下，我想好奇資本支出方面是否有什麼值得指出的。

Apologies if I missed this, but it sounds like maybe perhaps you're expecting to use the excess free cash flow and the guide raised just for share repurchase? Or how should we think about that? Thanks.

如果我錯過了這一點，我很抱歉，但聽起來也許您希望使用多餘的自由現金流和僅為股票回購而籌集的指南？或者說我們該如何思考這個問題？謝謝。

We are not really revising our CapEx, as we started this year, we talked about $5.1 billion to $5.2 billion, we think [Silgan] generally be in that same range. As noted in our in our comments, we do expect based on the improved outlook in the updated guidance that we're going to spend about $6 billion in 2024 on share repurchase. So being the bulk of the increase from the improved results would be going towards share repurchase.

我們並沒有真正修改我們的資本支出，從今年開始，我們談到了 51 億至 52 億美元，我們認為 [Silgan] 通常在同一範圍內。正如我們在評論中指出的那樣，基於更新後指引中前景的改善，我們確實預計我們將在 2024 年花費約 60 億美元用於股票回購。因此，業績改善帶來的成長大部分將用於股票回購。

And let me add, Mike, if I may too be same to the capital. I think it's important to understand that we operate on an inpatient occupancy level in the mid low to mid 70s even in the second quarter, which is in addition to the fact we added 2% inpatient beds as I mentioned. So, our inpatient occupancy continues to grow reflecting the acuity of our patients, reflecting the overall demand, then reflecting the market share gains that we believe we're experiencing.

讓我補充一下，麥克，如果我也和首都一樣的話。我認為重要的是要了解，即使在第二季度，我們的住院率也處於 70 年代中期，此外，正如我所提到的，我們增加了 2% 的住院床位。因此，我們的住院人數持續增長，反映了患者的敏銳度，反映了整體需求，然後反映了我們認為我們正在經歷的市場份額的增長。

The second piece is our ambulatory network development. Again, we have about 2600 outpatient facilities and clinics across the company up 5% from where it was last year. Those are a component of our capital spending as well. And we will continue to look for opportunities from one market to the other to build out a network that serves our patients as we need to serve them.

第二部分是我們的行動網路開發。同樣，我們公司擁有約 2600 個門診設施和診所，比去年增加了 5%。這些也是我們資本支出的一部分。我們將繼續尋找從一個市場到另一個市場的機會，建立一個為我們的患者提供服務的網絡，因為我們需要為他們提供服務。

And the third piece is infrastructure. I mean we are in the infrastructure business; it requires us to have facilities that have the appropriate environment for our patients. We have to upgrade a basic element of those facilities and so forth and so a lot of that is maintenance. So half of our capital goes towards maintenance to keep our facilities where they need to be.

第三部分是基礎建設。我的意思是我們從事基礎設施業務；它要求我們擁有適合患者的設施。我們必須升級這些設施等的基本要素，其中許多是維護。因此，我們一半的資金用於維護，以使我們的設施保持在所需的位置。

And then the last thing for us is technology, we are investing more in our technology agenda because we see opportunities for it to support the companies next generation growth and allow us to serve our patients even better. So, our technology component of our CapEx as it continues to grow.

對我們來說最後一件事是技術，我們正在對技術議程進行更多投資，因為我們看到它有機會支持公司的下一代成長，並使我們能夠更好地為患者服務。因此，我們的資本支出的技術組成部分不斷增長。

All of this is in the backdrop of our long-term view on demand as we indicated in November at our Investor Day, we expect long-term demand to be in that 2% to 3% zone as well. And so, we have to build the necessary capabilities in our networks, in our facilities to be able to serve that demand and that's where our capital expenditure plan is intended to accomplish.

所有這一切都是在我們對需求的長期看法的背景下進行的，正如我們在 11 月的投資者日所表示的那樣，我們預計長期需求也將處於 2% 至 3% 的區域。因此，我們必須在我們的網路和設施中建立必要的能力，以便能夠滿足這一需求，這就是我們的資本支出計劃旨在實現的目標。

And let me clarify really quick. I said $5.1 billion to $5.2 billion is actually $5.1 billion to $5.3 billion in capital spending for 2024.

讓我快速澄清一下。我說51億到52億美元其實是2024年51億到53億美元的資本支出。

Thank you.

謝謝。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks. It sounds like you believe that the volume and the demand support this volume as a kind of a base for the future. Wanted to see if you could give a little color on the margin side of things.

萬分感謝。聽起來您相信數量和需求支持該數量作為未來的基礎。想看看你是否可以在事物的邊緣一側添加一點顏色。

Is this the right way to be thinking about the base and we think about next year, is there anything puts or takes that you would point to I know sometimes when volume comes in stronger than you plan for maybe a little bit more margin leverage than you would expect and maybe that might moderate or whether you mentioned the timing in the past about some you have a lot of payments.

這是考慮基礎和我們考慮明年的正確方法嗎？ ，也許這可能會緩和，或者您是否在過去提到過一些您有很多付款的時間。

Is there any obvious headwind from timing from this year into next year we should be thinking about as we think about margins and EBITDA sustainability. Is this a good base for thinking about next year's growth?

在考慮利潤率和 EBITDA 可持續性時，我們應該考慮從今年到明年的時間表是否有任何明顯的阻力。這是考慮明年成長的良好基礎嗎？

Kevin this is Sam, speak to 2025. I will tell you that we do not have any unusual events thus far through first six months of this year. This is core operations on enhanced, as Mike said, slightly by the the Medicaid supplemental programs. So as a sort of a core operational level of performance.

凱文，我是山姆，請談談 2025 年。正如麥克所說，這是由醫療補助補充計畫略微增強的核心業務。因此，作為一種核心操作層級的效能。

It's really quite clean by comparison to some of the choppiness that naturally occurs with COVID with them with the supplemental payment timings and so forth. With some of the challenges we experienced last year with just the inheritance of Valesco and so forth.

與新冠肺炎自然發生的一些波動以及補充付款時間等相比，它確實相當乾淨。去年我們經歷了一些挑戰，只是繼承瓦萊科等等。

But when we look at the first six months and we think about the balance of the year. This is really a solid operational performance, supported by strong volume and not really unusual items benefiting or dragging the business in any material way. That's how I'd answer that question.

但當我們回顧前六個月時，我們就會想到今年的剩餘時間。這確實是一個可靠的營運業績，得到了強勁銷售的支持，而且並不是真正以任何實質方式受益或拖累業務的不尋常項目。我就是這樣回答這個問題的。

Thanks.

謝謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

Hi, good morning. I just want to go back to labor for a second, obviously, impressive results. Is there anything particular in recent achievements driving these results maybe past throughput and length of stay reduction and maybe how to think about that carrying forward over the next few quarters?

早安.我只是想再次分娩，顯然是令人印象深刻的結果。最近的成就是否有什麼特別之處推動了這些結果，可能是過去吞吐量和停留時間的減少，以及如何考慮在接下來的幾個季度繼續推進？

And then just there is some potential M&A, larger deals in the market, both on the hospital and the ambulatory side understand in markets tends to be where you focus, but can you maybe just remind us of the parameters that you would need to entertain maybe a more larger market or national expansion? Thanks.

然後，市場上有一些潛在的併購、更大的交易，無論是在醫院還是門診方面，了解市場往往是您關注的重點，但您能否提醒我們您可能需要考慮的參數更大的市場還是全國擴張？謝謝。

Yes, labor as we've already said, the biggest driver, if you think about our performance in the first half of the year compared to prior year, was this reduction in contract labor and that kind of comes through all the work we've been doing over the last several years, improving our recruitment activities and really working on retention.

是的，正如我們已經說過的，如果你考慮一下我們今年上半年與去年相比的表現，最大的推動因素就是合約工的減少，這來自於我們所做的所有工作過去幾年我們一直在努力改進我們的招募活動並真正致力於留住人才。

On the recruitment side, you've heard us talk about our academic affiliation work, our work around the game and School of Nursing. And all of that is kind of producing crude supply of nursing into our markets, which has been super beneficial. I do think from a contract labor perspective, as I noted in my comments, we're down to 4.8% contract labor as a percentage of salary wages and benefits?

在招募方面，您已經聽到我們談論我們的學術聯繫工作、我們圍繞遊戲和護理學院的工作。所有這些都在某種程度上為我們的市場提供了原始的護理供應，這是非常有益的。我確實認為，從合約工的角度來看，正如我在評論中指出的那樣，我們的合約工佔工資和福利的百分比已降至 4.8%？

Yeah, I do think that the go forward improvement, we'll still have some we've got it, as you've noted from our comment on guidance that we think will run probably in the mid four range in the back half of the year. So, there's some improvement in the future.

是的，我確實認為，前進的改進，我們仍然會有一些我們已經得到的，正如您從我們對指導的評論中指出的那樣，我們認為可能會在後半段的中四範圍內運行年。所以，未來會有一些改進。

But I think the big move on contract labor from the height of COVID really have been reflected now and what's to come is more incremental improvement as we continue to work on recruitment and retention. So that would be my, I don't see anything other than, that's material related to driving labor trends, productivity remains good, wage inflation has been stable, especially kind of coming off COVID and into 2024. So those are the major things that we think about when we think about from now to the back half of the year.

但我認為，從新冠肺炎疫情最嚴重時期開始，合約工方面的重大舉措現在確實已經得到體現，隨著我們繼續致力於招募和留住人才，未來將會有更多漸進式的改進。所以這就是我的，我沒有看到任何其他與推動勞動力趨勢相關的材料，生產率仍然良好，工資通脹一直穩定，特別是在擺脫新冠疫情和進入 2024 年的情況下。思考從現在到下半年的時間。

Mike, let me just put a wraparound that I mean, our focus now is finding ways to help our employees succeed even more what they do. So, we are investing in education of our existing workforce just as much as we're investing in education and new nurses and so forth. We are improving our processes around supporting our caregivers so they can deliver better care.

麥克，讓我概括一下，我的意思是，我們現在的重點是尋找方法來幫助我們的員工在他們所做的事情上取得更大的成功。因此，我們對現有勞動力的教育進行投資，就像對教育和新護士等進行投資一樣。我們正在改進支援護理人員的流程，以便他們能夠提供更好的照護。

We have a number of initiatives that are connected to our nursing operations and so forth that really make sure that we have resources and support for our caregivers on a day in and day out basis. And we're investing heavily in our leadership because good leaders produce good outcome for our patients and good outcome for the organization, so those things are wrapped around to what Mike just alluded to.

我們有許多與我們的護理業務相關的舉措等，真正確保我們日復一日地為我們的護理人員提供資源和支援。我們正在大力投資我們的領導力，因為優秀的領導者可以為我們的患者帶來良好的結果，也可以為組織帶來良好的結果，所以這些事情都圍繞著麥克剛才提到的內容。

With respect to M&A, we have added to our platform this year with some tuck-in acquisitions from one market to the other in Texas, as Mike alluded to we added a number of hospitals to our North Texas market, small, but very complementary and we're starting to see good results out of them. In Houston as an example, we added an outpatient business to our network there that has produced a very good outcome.

關於併購，我們今年在我們的平台上增加了一些從德克薩斯州一個市場到另一個市場的收購，正如邁克提到的，我們在北德克薩斯市場增加了一些醫院，規模雖小，但非常互補，我們開始看到他們取得了良好的成果。以休士頓為例，我們在網路中增加了門診業務，並且取得了非常好的效果。

We are built to be bigger; we know that, and we have the balance sheet to support that. But we're very selective and around making sure that an acquisition fits the model and can produce the returns that we expect from acquisitions. Will we enter new markets? Hopefully, yes, but those opportunities haven't necessarily presented themselves.

我們生來就是為了變得更大；我們知道這一點，我們有資產負債表來支持這一點。但我們非常有選擇性，並確保收購符合模型並能夠產生我們期望的收購回報。我們會進入新市場嗎？希望是的，但這些機會不一定會出現。

I don't know that we'll deviate from our model, our model is more centered on making our system, our local system work better, work better for the community, work better for our patients and work better for other stakeholders that are connected to it. We obviously could do that, but we don't think that's the best answer for the company and that's been part of what we define as the durability of HCA Healthcare.

我不知道我們會偏離我們的模型，我們的模型更側重於讓我們的系統、我們的本地系統更好地工作，更好地為社區服務，更好地為我們的患者工作，並為其他相關利益相關者更好地工作到它。我們顯然可以做到這一點，但我們認為這不是公司的最佳答案，這也是我們定義的 HCA Healthcare 持久性的一部分。

It's staying true to the model in ways that produce a really good outcomes for our stakeholders. It's possible that something will cause us to deviate from that, but we haven't really seen it up to this point. So, our focus is on investing back in our business, doing selective strategic acquisitions that complement our networks where we can and really advancing our position in these great markets that we serve.

它忠於模型，為我們的利害關係人帶來真正好的結果。有可能某些事情會導致我們偏離這一點，但到目前為止我們還沒有真正看到這一點。因此，我們的重點是對我們的業務進行投資，進行選擇性的策略性收購，以補充我們的網絡，並真正提高我們在我們所服務的這些偉大市場中的地位。

And one more [covenant-light]. The other thing that was very helpful for us in not only in the quarter and year to date, is this 2% reduction in length of stay. So if you think about kind of how did we service is almost 6% growth in inpatient volume on the admission side, 2% reduction only to say, Sam mentioned this when we had a 2% increase in our bed count from our capital investment program.

還有一個[聖約之光]。另一件對我們非常有幫助的事情是，不僅在本季度和今年迄今為止，停留時間減少了 2%。因此，如果你考慮我們是如何提供服務的，入院方面的住院人數增長了近 6%，減少了 2%，只是說，薩姆在我們的資本投資計劃床位數量增加 2% 時提到了這一點。

And then our occupancy levels were up 2%, but that that 2% drop in length of stay and the ER efficiency that Sam mentioned earlier also supports our labor cost and efficiency in the way we're managing our labor. So, I wanted to add that as well.

然後我們的入住率上升了 2%，但 Sam 之前提到的入住時間和 ER 效率下降了 2%，這也支持了我們管理勞動力的方式的勞動成本和效率。所以，我也想補充這一點。

Thank you.

謝謝。

John Ransom, Raymond James

約翰·蘭塞姆，雷蒙德·詹姆斯

Hey, good morning. Great job. Just curious, a question we're getting is if you look at the back half. Do you happen to have the DPP compare of '23 versus '24? And you're back half.

嗨，早安。做得好。只是好奇，我們遇到的一個問題是你是否看後半部。你剛好有民進黨比較「23」和「24」嗎？而你又回來了一半。

Here's what I would say about the guidance on the back half of the year we talked about when we came into this year that we thought we would have a headwind of $100 million to $200 million from Medicaid supplemental payment programs. As we've gotten deeper into this year, we're now kind of changing that or updating that to a $100 million to $200 million tailwind.

以下是我對今年下半年的指導意見的看法，我們在進入今年時談到了我們認為醫療補助補充支付計劃將帶來 1 億至 2 億美元的阻力。隨著今年的深入，我們現在正在改變這一點，或將其更新為 1 億至 2 億美元的順風車。

So if you think about that slip of $200 million to $400 million, I would tell you that much of that already occurred in the first half of '24. So, if you think about the back half of '24. What we're expecting for supplemental payment programs will look pretty similar to what we had in the back half of 2023.

因此，如果你考慮一下 2 億美元到 4 億美元的下滑，我會告訴你，其中大部分已經發生在 24 年上半年。所以，如果你想想 24 年後半段。我們對補充付款計劃的預期將與 2023 年下半年的情況非常相似。

Okay. And if I could just take one more M&A. What is the year over year M&A contribution to EBITDA? Because it looks like in your cash flows, M&A has been quite modest, but it looks a little bigger in your tables. So, can we kind of was that fully in your guide the M&A effect when you guided for '24? Thanks.

好的。如果我能再進行一次併購就好了。併購對 EBITDA 的年比貢獻是多少？因為在你的現金流中看起來，併購相當溫和，但在你的表格中看起來有點大。那麼，當您指導 24 世紀時，我們是否可以在您的指導中充分了解併購效應？謝謝。

It is, I mean, I said earlier, if I think about M&A or another way to think that it's kind of new stores, it was through the second quarter is about a 1% dilution to EBITDA for the quarter in terms of the impact from M&A activity, that includes, by the way, Velasco.

我的意思是，我之前說過，如果我考慮併購或以其他方式認為這是一種新店，那麼從第二季度的影響來看，該季度的 EBITDA 大約稀釋了 1%。活動包括Velasco。

I would note that the Velasco moves into same-store in 2025. And so you'll see us kind of stopped talking about Velasco next year, but that M&A was not a material impact related to our earnings for the quarter.

我要指出的是，Velasco 將於 2025 年進入同店。 所以你會看到我們明年不再談論 Velasco，但併購併沒有對我們本季的收益產生重大影響。

And Mike, as it moves through the last half of the year, it gets slightly better and we're hopeful that by the end of the fourth quarter, it's not dilutive.

麥克，隨著今年下半年的進展，情況會略有好轉，我們希望到第四季末，情況不會被稀釋。

Great. Thank you.

偉大的。謝謝。

Joshua Raskin, Nephron Research.

約書亞·拉斯金，腎臟單位研究。

Hi, thanks. Good morning. Just getting back to the exchanges. I heard 7% of admissions now are coming from patients with ACA exchange coverage. What does that translate into revenues? And should we assume that those patients carry margins that are typical of the broader commercial population.

你好謝謝。早安.剛剛回到交流。我聽說現在 7% 的入院患者來自 ACA 交換保險的患者。這轉化為收入是什麼？我們是否應該假設這些患者的利潤率是更廣泛的商業人群的典型利潤率？

What we typically say about our healthcare exchange, there's a payer category is our second-best player. It's below from reimbursement level is below commercial, it's above Medicare. So, it's in between those. So, it would have margins less than your typical commercial margins that better than Medicare would be roughly what we're talking about. So, on the 7% of admissions, if you look at revenue or something like 8% to 9% of revenues.

在我們通常所說的醫療保健交易中，有一個付款人類別是我們第二好的參與者。它低於報銷水準低於商業，高於醫療保險。所以，它介於兩者之間。因此，它的利潤率低於典型的商業利潤率，而比醫療保險的利潤率大致就是我們所說的。因此，如果你看一下收入或 8% 到 9% 的收入，就佔 7% 的入場費。

Perfect. Thank you.

完美的。謝謝。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Yes, thank you. Sorry about that. Can you give us some clarity if the commercial outpatient surgeries that were delayed related to holidays in 1Q were rebooked. And then and just taking a step back, if I look at outpatient surgical trends in the first half last year was kind of mid-single digit redeterminations started and it dropped down to low single digits now to negative two for first half of this year.

是的，謝謝。對於那個很抱歉。您能否透露一下，第一季因假期而延遲的商業門診手術是否已重新預約？然後退後一步，如果我看看去年上半年的門診手術趨勢，就開始了中個位數的重新確定，現在下降到了今年上半年的負兩位數。

So is that like full change from the mid-single digits first half last year to now the negative two all related to Medicaid. And should we start to see that fall off in the back half of this year then. And as we start to anniversary some of the impact?

從去年上半年的中個位數到現在的負兩位數的完全變化是否與醫療補助有關？那麼我們是否應該在今年下半年開始看到這種下降？當我們開始慶祝週年紀念日時，會產生一些影響嗎？

Again, the volume declines on outpatient surgeries are associated with Medicaid declines in that category as well as the uninsured self-pay category. So, both of those categories explain here today, pretty much, 100% of volume declines. I mean there's the thesis inside of our company it's not proven yet that the patients who migrated from Medicaid into the exchanges through the redetermination process may be in a different seasonality category with respect to when they access services.

同樣，門診手術量的下降與該類別以及無保險自費類別的醫療補助下降有關。因此，今天這兩個類別幾乎可以解釋 100% 的成交量下降。我的意思是，我們公司內部有一個論點，尚未證明透過重新確定過程從醫療補助轉移到交易所的患者在獲得服務時可能處於不同的季節性類別。

So that's a theory we have we'll have to see how that plays out as we move through the balance of the year. But I think it's important to understand that the revenue growth, the service level growth that we've seen in our outpatient surgery business has been solid and produced a pretty good financial outcome for the company.

所以這是我們的理論，我們必須看看在今年剩下的時間裡它會如何發揮作用。但我認為重要的是要了解我們在門診手術業務中看到的收入成長和服務水準成長一直很穩固，並為公司帶來了相當不錯的財務成果。

And if in fact, our thesis is accurate, it should be up better in the second half of the year in the first half of the year. But again, we don't know that for sure, we need to experience this change in our business with this movement from one payer class to the other before we can land on that being the situation.

事實上，如果我們的論點是準確的，那麼下半年應該會比上半年好。但同樣，我們不確定，我們需要經歷業務中的這種變化，從一個付款人階層到另一個付款人階層的轉變，然後才能實現這種情況。

Here, I would just add on Medicaid redeterminations. You know, we're about one year into the redetermination process in most of our states. But you remember from last year you really started to gain speed towards the end of last year. So, I don't think you'll sunset our anniversary year into the full Medicaid year over year comparison period until you get closer to the end of the year.

在這裡，我只想補充一下醫療補助的重新確定。你知道，我們大多數州的重新確定過程已經進行了大約一年。但你記得從去年開始，你在去年年底才真正開始加速。因此，我認為在接近年底之前，您不會將我們的周年紀念年納入完整的醫療補助逐年比較期。

This now concludes our question-and-answer session. And I'd now like to hand back over to Mr. Frank Morgan for final remarks. Thank you.

我們的問答環節到此結束。現在我想請弗蘭克摩根先生做最後發言。謝謝。

Elle, thank you so much for your help today, and thanks for everyone joining our call. We hope you have a great week and a successful earning season. I'm around this afternoon, if I can answer any additional questions you might have. Thank you.

Elle，非常感謝您今天的幫助，也感謝大家加入我們的通話。我們希望您度過愉快的一周和成功的賺錢季節。我今天下午就在，如果我能回答你可能有的任何其他問題。謝謝。

Thank you, everyone, for attending today's conference call. You may now disconnect. Have a wonderful day.

謝謝大家參加今天的電話會議。您現在可以斷開連線。祝你有美好的一天。